Healthcare Provider Details

I. General information

NPI: 1811939937
Provider Name (Legal Business Name): DANA KATHERINE ROBBEN-FOLSOM P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W FOOTHILL BLVD
GLENDORA CA
91741-3361
US

IV. Provider business mailing address

440 W FOOTHILL BLVD
GLENDORA CA
91741-3361
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-9402
  • Fax: 626-914-5316
Mailing address:
  • Phone: 626-963-9402
  • Fax: 626-914-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: